Provider Demographics
NPI:1033240650
Name:LUIS A. GALDAMEZ, MD INC.
Entity Type:Organization
Organization Name:LUIS A. GALDAMEZ, MD INC.
Other - Org Name:CLINICA MEDICA VIRGEN DE GUADALUPE #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-581-8234
Mailing Address - Street 1:6831 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4805
Mailing Address - Country:US
Mailing Address - Phone:323-581-8234
Mailing Address - Fax:323-581-0393
Practice Address - Street 1:6831 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4805
Practice Address - Country:US
Practice Address - Phone:323-581-8234
Practice Address - Fax:323-581-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61918207R00000X
CAA048644208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067941Medicaid
CAGR0067941Medicaid